Journal of neurosurgery
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Journal of neurosurgery · Jun 2024
Observational StudySame-day discharge after craniotomy for tumor resection: a retrospective observational single-center study of 630 patients.
Modern neurosurgical developments enable minimally invasive surgery with shorter operation times, faster recovery, and earlier hospital discharge. These in combination with Enhanced Recovery After Surgery (ERAS) protocols have the potential to safely shift craniotomy for tumor resection to the ambulatory setting in selected patients. The aim of this retrospective observational single-center study was to assess the success rate of planned same-day discharge from hospital in patients undergoing craniotomy for supratentorial brain tumor resection under general anesthesia or awake craniotomy as well as to explore potential associations with anesthesia techniques, complications, and readmission rates. ⋯ This retrospective, single-center analysis shows that same-day discharge after craniotomy can be safe in carefully selected patients after both GA and AC for tumor resection. Multidisciplinary involvement (surgeons, anesthesiologists, nurses, and other allied health professionals) optimizes success of same-day craniotomy programs. Future optimization of analgesia and prevention of PONV has the potential to increase the success rate.
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Journal of neurosurgery · Jun 2024
Predicting incomplete occlusion of intracranial aneurysms treated with flow diverters using machine learning models.
Intracranial saccular aneurysms are vascular malformations responsible for 80% of nontraumatic brain hemorrhage. Recently, flow diverters have been used as a less invasive therapeutic alternative for surgery. However, they fail to achieve complete occlusion after 6 months in 25% of cases. In this study, the authors built a tool, using machine learning (ML), to predict the aneurysm occlusion outcome 6 months after treatment with flow diverters. ⋯ In this study, an ML-based tool was developed that successfully predicts outcome in intracranial aneurysms treated with flow diversion, thus helping neurosurgeons to practice a more refined approach and patient-tailored medicine.
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Journal of neurosurgery · Jun 2024
Delayed facial palsy after resection of vestibular schwannoma: does it influence long-term facial nerve functional outcomes?
Delayed facial palsy (DFP) is a common and unique complication after resection of vestibular schwannoma (VS). Few studies have focused on the clinical question of whether patients with DFP can be expected to have the same long-term prognosis in terms of facial nerve function as those without DFP based on their facial nerve function immediately postoperatively. This study aimed to clarify the clinical impact of DFP on the long-term functional status of the facial nerve after VS resection. ⋯ DFP can be a minor complication when normal facial nerve function is observed immediately after surgery. However, when facial nerve dysfunction is present immediately after surgery, even if mild, the long-term prognosis for facial nerve function is significantly worse in patients with DFP than in those without DFP.
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Journal of neurosurgery · Jun 2024
Clinical outcomes following stereotactic radiosurgery for cerebral cavernous malformations of the basal ganglia and thalamus.
There are few reports of outcomes following stereotactic radiosurgery (SRS) for the management of cerebral cavernous malformations (CCMs) of the basal ganglia or thalamus. Therefore, the authors aimed to clarify these outcomes. ⋯ SRS is a reasonable treatment strategy and confers clinical stability or improvement and hemorrhage avoidance in patients harboring CCMs of the basal ganglia or thalamus. An MPD of approximately 12 Gy is recommended for the management of CCM.
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Journal of neurosurgery · Jun 2024
Electromyographic predictors of abducens nerve palsy after endoscopic skull base surgery.
Recovery of abducens nerve palsy (ANP) after endoscopic endonasal skull base surgery (ESBS) has been shown to be potentially predicted by postoperative ophthalmological examination. Triggered electromyography (t-EMG) and free-run electromyography (f-EMG) activity provide an intraoperative assessment of abducens nerve function, but associations with long-term ANP outcomes have not been explored. The objective of this study was to describe intraoperative abducens EMG characteristics and determine whether these electrophysiological profiles are associated with immediately postoperative and long-term ANP outcomes after ESBS. ⋯ The presence of f-EMG activity, lack of CMAP response to stimulation, decreased CMAP amplitude, and increased CMAP onset latency were associated with immediately postoperative ANP. Long-term ANP outcomes may be associated with t-EMG parameters, including whether the nerve is able to be stimulated once identified and CMAP amplitude. Future prospective studies may be designed to standardize abducens nerve electrophysiological monitoring protocols to further refine operative and prognostic utility.